M6 Midterm Flashcards
Occlusion of the ___ artery from stenosis, aneurysm, embolus, or compression from a cervical rib or anomalous first rib is the most serious cause of TOS, but accounts for less than 1% of all cases.
Subclavian
___ TOS is by far the most common cause of TOS, accounting for well over 95% of cases.
Neurogenic
TOS is more common in ____, with some estimates as high as 9:1
Women
In TOS, pain and paresthesia predominantly involve the __/__ segmental level
C8/T1
Symptoms of TOS follow a ____ nerve distribution in 90% of cases.
Ulnar
A buffalo hump in the upper thoracic spine may indicate ___ syndrome
Cushing’s
Scapular winging can be due to weakness of what three muscles (or their associated nerve supply)?
- Serratus anterior (long thoracic n.)
- Lower traps (spinal accessory CN XI)
- Rhomboids (dorsal scapular n.)
For patients with increased thoracic kyphosis, what test help differentiate between a structural or functional cause?
Prone extension test
The two basic origins of intersegmental joint dysfunction (ISJD)?
- Mechanical (trauma or overuse)
2. Reflexive (visceral nociceptive irritation triggering reflexive segmental muscular guarding)
Longstanding joint dysfunction is thought to result in premature _______
Degenerative change
Complaints involving the thoracic region make up approximately __% of all spinal problems
15%
The one-year prevalence of thoracic spine pain is estimated at __% (much lower than cervical/lumbar)
17%
The use of ____ seems to correlate with adolescent thoracic spine pain (approx. 10% of adolescents experience thoracic pain)
Backpacks
Clinicians should be suspicious of ____-referred pathology when active or passive motion testing does not reproduce the chief complaint.
Viscerally
MRI demonstrates the presence of thoracic disc herniation in __% of asymptomatic patients, and disc bulge in __%
37%, 53%
Thoracic spine manipulation has been shown to immediately increase _____
Muscle strength
___ syndrome consists of paresthesia, numbness, upper extremity pains w/or w/out headaches and upper back stiffness. It has a peculiar glove-like distribution of hand or forearm pain which often leads to misdiagnosis.
T4
Studies suggest that __-__% of “chest pain” is of musculoskeletal origin
10-30%
The costovertebral joints have rich, nociceptive innervation from branches of the ____ nerve
Intercostal
The intercostal nerves arise from the ____ rami, which provide a plausible connection for referred pain to the chest and abdominal wall.
Ventral
Movement of the upper ribs occurs primarily in a “____” elevation manner, while the lower ribs move in more of an anterior to posterior “______” fashion
“Pump handle”, “bucket handle”
The __-__ segments are the most common sites of costovertebral joint dysfunction.
T8-T10
Ankylosing spondylitis is suggested when chest expansion is limited to less than __” in males and __” in females.
1-1/2”, 1”
Asymptomatic thoracic disc lesions may be present in up to ___ of the population
Half
Over 75% of thoracic disc herniations occur below ___, with the ____ segment being affected the most.
T8, T11/12
Costovertebral joint dysfunction is generally unilateral and provoked by _____
Deep inspiration
Patients w/thoracic disc herniations whose symptoms centralize upon EXTENSION should be treated w/a ___ extension protocol, while patients exhibiting a flexion bias would be better served with _____ flexion exercises.
McKenzie, Williams
____ is a complicated diagnosis, broadly describing dynamic, interdependent degenerative changes involving the discs, vertebral bodies, and/or facet joints that develop in response to stress, compounded by time.
Spondylosis
Thoracic degeneration shows a predilection (common area of damage) for the most mobile segments: __-__
T9-T12
Spondylosis patients often note symptoms upon arising in the morning which dissipate with _____
Light activity
____ describes a painful inflammation or degeneration of the tendon of the long head of the biceps.
Biceps tendinopathy
Biceps tendinopathy often results from repetitive ___
Overhead activity
____ is the most common cause of shoulder complaints, in which 95% of patients with biceps tendinopathy have it as their primary diagnosis.
Subacromial impingement
A popular orthopedic test for bicipital tendinitis?
Yergason’s
____ syndrome is caused when the Supraspinatus tendon becomes painfully entrapped between the acromion and the greater tuberosity of the humerus during elevation and internal rotation of the arm.
Anterior shoulder impingement
“Non-outlet impingement” anterior shoulder impingement syndrome arises from loss of normal numeral head depression as a result of ____ muscle weakness or denervation
Rotator cuff
Scapular dyskinesia is present in up to __% of shoulder impingement cases.
100%
Which of the rotator cuff muscles is the largest and strongest?
Subscapularis
____ injury is the most common problem to affect the shoulder, accounting for 4.5 million physician office visits per year.
Rotator cuff
____ describes an ongoing and painful limitation of active and passive glenohumeral and periscapular motion
Adhesive capsulitis (frozen shoulder syndrome)
There are two types of adhesive capsulitis: primary and secondary. Which type is more common and follows a period of restricted shoulder motion (i.e. rotator cuff pathology, trauma, surgery, etc.)
Secondary
Patients with ___ adhesive capsulitis are unable to identify the cause of their condition
Primary
The incidence of adhesive capsulitis rises to 10-20% in patients with _____, and 36% in those with _____
Type 2 diabetes, Type 1 diabetes
Loss of passive ____ with the arm positioned at the side is the most common range of motion deficit in adhesive capsulitis
External rotation
The acronym “SLAP” stands for:
Superior Labrum Anterior Posterior
___ is described as a tear or detachment of the shoulder’s superior glenoid labrum; generally originating at the anchor site for the long head of the biceps tendon and extending into the anterior or posterior portions of the labrum
SLAP Lesion
The most common mechanism of acute SLAP lesion injury?
FOOSH (Fall Onto Outstretched Hand - shoulder abducted and flexed forward)
Also called “sick scapula”
Scapular dyskinesis
Scapular dyskinesis is more apparent with dynamic testing, particularly during the ____ phase of arm movement.
Lowering
T/F: scapular dyskinesis can occur from core and hip abductor weakness
TRUE
T/F: no single orthopedic maneuver has been shown to reliably predict a SLAP tear.
TRUE
10% of patients with lateral epicondylitis have co-existent ___ syndrome
Radial tunnel
In radial tunnel syndrome, the radial nerve compression occurs most commonly (70%) beneath the proximal edge of the ____ muscle at the Arcade of Froshe
Supinator
__% of patients with lateral elbow pain demonstrate symptoms or positive clinical findings in the cervical or upper thoracic regions
70%
Radiographs are warranted in adolescents complaining of medial epicondyle pain in order to rule out avulsion, also known as:
Little league elbow
The two most common sites of ulnar nerve entrapment at the elbow are:
- Within the true cubital tunnel
2. Slightly distal to the tunnel between the two heads of the flexor carpi ulnaris
This is the second most frequent cause of median nerve compression
Pronator teres syndrome
A patient with this syndrome cannot form an “O” with the thumb and index finger
Anterior interosseous syndrome
The most common nerve entrapment?
Carpal tunnel syndrome
